Lateral Knee Pain

Introduction

 

It is amazing that, although we automatically associate knees and feet together from a very early age, this is not always the case in the medical profession. It seems that hospital orthopedic consultants are categorised by the joint with which they are regarded as specialists. And they will equally confine themselves to that role with many a retort from knee specialists that they '... don't do feet...', and likewise from the feet specialists that they '... don't do knees...' For the patient, however, the speciality should colloquially be termed 'the leg'.

 

I truly don't intend any disrespect to the medical profession. You study and accumulate a great deal of knowledge; you learn how to use and apply your knowledge; but this is perhaps not beyond the realm of quite a few people; however, for you, it is far more than this... you actually have the guts to cut open another person's body...! However you need to realise the implications that this has for the patient... and this all boils down to 'waiting times'. Mostly, by and large, there seems to be a 3 month wait for appointments, whether that's to see a consultant, for MRI scan, for an ultrasound scan, or whatever. Generally x-rays are done that day, and appointments for physiotherapy are usually quicker. It is sooooo easy to clock up years just whilst waiting... and in the mean time, traumatic injuries may manifest signs of degenerative issues... and that's forgetting about the pain and/or discomfort that the patient is living in...!

 

Anyway, legs are frequently the recipients of a variety of sporting injurys, which may involve, for example, the foot, knee and hip, when you land on your foot, bend your knee and rotate your hip, or should that be the other way round... Nevertheless it does illustrate an order of involvement of joints to produce a function, for example jogging. This is known as the kinetic chain, which should provide a starting point and an end point, between which a variety of issues may arise. 

 

https://www.acefitness.org/blog/2929/what-is-a-kinetic-chain discuss the kinetic chain:

(2012)

... the extremities be viewed as a series of rigid, overlapping segments and defined the kinetic chain as a "combination of several successively arranged joints constituting a complex motor unit." The movements that occur within these segments present as two primary types—open and closed...

Open-chain Movement

... open kinetic chain is defined as a combination of successively arranged joints in which the terminal segment can move freely.

Closed-chain Movement

... closed-kinetic chain... the distal end of the extremity is fixed, emphasizing joint compression and, in turn, stabilizing the joints.

 

After a sporting injury, these points will demonstrate the place of the initial cause of the injury from which other injuries may stem, and ending with the final, possibly life-changing event in the kinetic chain. In my case, it was a closed kinetic chain, with my foot fixed firmly on the ground, leaving me with a range of problems from tripping over things because I could't lift my leg high enough to clear them, to being unable to walk properly due to a varitey of pains and a feeling of stability in my knee.

 

The muscles, used in the kinetic chain involved in my injury, run from the bottom of the foot to the muscles around the hip, and their inhibition and facilitation are discussed by:

http://neurokinetictherapy.wordpress.com/2012/04/22/the-popliteus-the-tiny-muscle-of-knee-pain/

 

KINETIC CHAIN ANALYSIS

In the superficial back line, there is a chain from the bottom of the foot, through the calf muscles, to the popliteus, to the hamstrings, and the gluteus maximus. In the extension phase of gait, these muscles work together. Inhibition of one or more of these muscles may cause another muscle in this chain to become facilitated. The popliteus may become facilitated due to inhibition of the gluteus maximus...

In internal rotation of the tibia, inhibition of the medial head of the gastrocnemius may cause facilitation of the popliteus. In external rotation of the femur, inhibition of the biceps femoris may cause facilitation of the popliteus. [And even] compensation patterns involving the popliteus due to inhibition of the neck extensors, flexors, and rotators.

 

This highlights the importance for consultants to consider the whole history of an injury, as indicated by the Royal College of Surgeons in their training courses at

http://www.rcseng.ac.uk/courses/course-search/advanced-arthroscopic-knee:

 

Clinical Assessment

A sound knowledge and understanding of:

History and examination of the knee to include relevant surrounding structures​​

The standard clinical signs of the knee and relevant adjacent structures and competent skill in describing these

 

To ask a patient to suggest 'What is the main problem?' is not good practice because:

1. it excludes all previous history which may have relevance to the current problem,

2. it excludes all previous history which may highlight an additonal problem that may have produced the current problem,

3. it makes the assumption that the patient is knowledgeable enough to suggest what is most important.

 

And, even as a local consultant did, asking the patient '...what was the first problem you remember after the injury...' relies upon patient recall, which may be several years previous, and may not even relate to the injury anyway... 

 

I did have the symptoms of a lateral meniscus tear and it did show on the MRI scan... but I believe that this is not the cause of my problems. It seems to me that it is a consequence of the problem, not the cause. However in dealing with it alone, there are further problems arising... and still initial problems that have not been addressed...

 

So to all patients: Always start at the beginning even if the consultant is short of time... it will save you time and a great deal of pain... and will save the NHS a great deal of money, and free up time that could be devoted to other patients who are also in a great deal of pain too...